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HomeMy WebLinkAbout1444A (8) ' ., ; ' .. . ": ��.. F . t � VJ�ORKERS COIv�P�'NSAT(ON DEClAftA71bN �' ` �"..: +,. . ��A��L9C/��I���P'��1'�������/y♦IT ., ,l . • . �V _ ... .„, r ..... ..,. �o Sa ce�f ed co�f�heref W eker3s8�Com eeosatibn Insurancef CE B17 REV.�0.�81� � - - � ... z;� � . .. .. Z � 1' � . 76A667A � . �` � _ . P � . .( . .) --� -"�. ... ., ._, . . _.�. � . ... . ...., . . . .. Gy�1 y� PY e¢� '" o iob.c.> �/� COUNTY OF COS ANGEtES BI�ILb1�IG AND SAFETV' ��� Pol�cy No�V�C�pany� �; rv . � . .� . , . -,._.�. _... ��-� -�. 7 _ � -s�s ,. � Ceqif�ed copy is hereby furnished. � , � � . . . �� - � FORAPGLICANi'TOFILLIN(PRINTORTVPE)� ' BUILDING /. ,.�y � �� � � pY� ' Y� 9 P NqMBER WATERCLO ETUREOR ITEM - ADDRESS C.��C= � t pg� a f en}� Pp ^ C4' FEE �'. Certrfied co s f led wrth the cou t buildin ins ec- ,. (/ � y`�--J ��c_° P (!C"g/ . LOCALITV 6ate � 0 �A I can�t_� `J�•F7[e/'� _ . � �. NEARE57 . .. . . s �ERTffIC1SiEOK"ES�E7vl�Y1(JT�i�FI�"b'M" k.Ef15,,..:.,,..":.....�:.� .�, �; BATHTUB - - � . �,� CROSS�ST. . . . = � tt�MPENSATION INSt1kANCE��� SHOWER - � -- OwNEg - ,�(Thls secHon eee�not�be comple4ed if fhe work�nvorved Sy��, - Ma�� _. fhe permif 1s For ene hundred sYoOcrs�'�YbO�o��ess� � IpVATORY . . �Y1i ADDRE55'. . . . . . ` ��1 cert f`y lhat in 1he performonce o�rhe vrork,fpr wFfa'h iFis� � �, � -� SINK-' �� � � �pc�rmrt is issued I shalt no1 employ qny pe 5on�n pny manner � � - � .�' CiN � � - �,,so as fo become sub�ect to the Workers Compensat pn Ldws � �DISHWASHER�- �� � � �i['��� -� � ';/� � , : ; .: ': y � " :-^ . . - CONTRACTOR � .. �� ' �Dqte � Appl�cont � �� � CLOTHES WASHER' � � � e' - ',, .�^- � AODRE55 `� "' /,�LIh I'�'TPce aO��PI�a tlslp o hs o4n s obC�c�t tPe hem h II eba � LAWN SPR N�RLSV TEM R . . . STATE��'�,y. , . c�"� ...�`r' ��'���J 3c7 E de�med ievoked �� . - � ��WATER HEATEa�� �- � -r� LICENSE NO �7 j���b..7 . �CLASS C'-�b ,,� ha ,LICENSED C�Nl"RACTL'�`�S' ECCRRATTCSPI " "'.�- - . � � � - •.^ ,�� .,� , .. ,.: � :Dt$TRICTfYd:.' .. PROCE$SED�BV � . . . ". ,�',` .GAS SYSTEM OU7Y�75 . .,�.�. _l � , i'he eby aifirm lhat I�am�licensed un�er provis ons of Chapte�q �� f � V . � . y,,;(commenc n with Secfion 7'OOp of:Divis�on 3 ot the Business °� '�`�- � � � . 9 � . OU7lET5 6VER � � 'and Professiqns C de,and my license is in full farce and effect: 5 PER�SYSTEnn � -� FINAI��. � �c-��� VALI TI�N y,2 � l�cense N�mber���� �.. lic.Clpss� � . . . . . . � DATB _ 2".�� � ,�, �j �J.}'��n[ . FINAL - � � U. Contractbr��"C"�" •` � Dafe��'? , - . BY.- . � ' � I am exempt under Sec �. . .. . .. � �. - � We&P C fo�rh s reason 4 Plan check fee � a. :.oate .. . . - fn PLUMBING.PERMIT ISSUINGFEE$ �� jy(�,/,�A , z Signalu e . . ... � � —. TOTAC�FEE� . � � - �o e a s e� . . ' . ._ Plancheck�applicanf�. - . . .. . . .,, ! a w 88.5Q <' .; a SINGLE fAMILY " ." .. . . . . ' � . . . . .. : ,NOMEOWN�R BUItbER 6�'CEARFfYIOCy � Name � - � . -. �" _ � . .: , ..... . ,...e � g�:�5�u., �,.,,.. .�. ,�.,.., .. .,.. _�,, .. ._. _.. ��reby a�firm thpt I qm exemp�from�he Contractor si cense � -- � � � � � -_ .v for the�#oflowi�g ieason (Section 703f:5,8us ness�qnd Address . „ _ � - � . . - 'Prafesaions�ode).� - �ity � .. :.�Tel No. .��.` . . ... . .. .. ��.� v'"'8 7 , .❑_ .., :., . . ... ._ .. _ . .. . . � . ' I os o ner of the prope ty w II do ihe work and the � : , •. srruduie s nor 'ntended or offered 4or sale (Seciron � . � -�- � -- � - � �- � � �� ��-�� - �" �� 7044,Bus ness and Profess ons Codel. �`� � ' � . . � ... . . .. .,. . . ., . . .:.. . .: :.;' ., . .. i � � '':CQNS7RCIGYION LEI�DING AGENCI�` �. . , ,., .,. . . . � . ." . . �. � - . .,, _ ..e . _. ..r , w �_� .. .� ... ,�,.�.. .._,,, ..�. ..,.� _. _.. I�hereby if rm tha't�rhere s a ccsnstruchon fending agency fpr � . � -. tFi�e performance of the waik tor which this�permit�is issued � � - � � � � - � . .__. . ..:_. . . _..�. . _ .._. ..... ._... ._.. . - ..:_ . . . .,..,. ,. ... �, ,{Sec 3097,'Ci C.). � � � � - � -� � � .r . _. r,; � f,. � , .;, ., � ,- , ..�,ia ;-r �,.�, . ..i . . ��, . - ,.. .,..= -��- ,. Cende s Name ' � " � t , "Cender s Add ess � � -ti-. . ��_ t _ .. � i� .. ,._ , , . . �1 cert fy rhat I ha e ead this appiicat on and 5iate that�'the ... .. .;�� � . . ..... . . ... . . . .. . . . . . �'abo e r formoi o s eorrect I qgree,ro comply w th olf Coonfy '' ' � � ' �`o d nances qnd State�lav�s,`reguloHng Plumbing;qnd hereby . � � . . .��b fh,onz representptwes.of.th!s Gouniy fo'enter upoir�:fhe . �� � . - .. .... ._ . ..abave��� �tione a en f r in �echon . . r: . . . .... ,- . . _, ..,,.... __,.. ,..,., .,_ .,.. . . pr p y purposes . . _ ,, ; ^' �ry��yro i-) SEE REVERSE FOR EXPIANATORY LANGUAGE ' �-� :, � � '/ CD 1 � � ...,9nature�of�Permitfee � Date : � , . �. .. � . ... _ '. . . -_. � .. .. �� ..�'s � ' `< � .e��,,�... �.-----�� m . . . . ._���. ., INSPCTOR'S�,-t�,3'fES ...w...,.: . .��� �,.�,«i:my ��I'� � :�.,a.�.:�.��.: -....,m.»,a,. � . �,. � , APPROVFt$ . ��.T � .NSP� R �.fGf�ATU�E ' ' � � ' �' '.... �... _ ..... ,v,..�...:..._ ,.<..w.,...�»�«.:��+w' w; z�..,..,> m x.xr..�rnu..w..a�.-r.-�.-�w.....�..,,_� . UNDER S�AB W6RIC`.�` ',_% ' ', � � ,.� . . � � - I hereby affi.�m thal I pm ezempt{.�,om.:n_CeYrccror;W�. . ASFPING�81NC � � � �� � �W�WN r. ����� =�'�ense Law fot th folla� nq reason (5e i 0�^i.5. ' ^ -- ' !3 smess ond Profes ons Co�e)'Any diy or cc rty� ;i�r.h ._,_ ��� � _ — ��•� �^�r�quir¢s a permit fo co t uct,aHer ,mpro e derro�;sh, ' ,.,..,,... �.,., .,,,� .... � 6A5 VENT- � - i'- '`-,y �- „ �€ � - br�repair,any s>ructu e orior to ts iss,unnca, also.re- . HO?WATER NEATER� � � ~ p� � �� " ' � � - "' '-"�'��"" ^�"`"'^"'""°"""""�'""�res the applicanf-for suchpe�mif 10 1i1e�a signed stcte- �.PLIiMB{NGFIXiF1RE5 ' ., �. .,. ... .�.. .,.,..,.w,,-. ... .. �..:,, , , �.....: ...... ... . -�,:... ..,... � ........ .. • m"enf tbaS he,is lic�onsedpurmoant to the provl,ions oF'he � GASTES � ���. a� � � ' ""� ` �'Cortrac'ars Licens�Lai (Chop+ 9(com nc y ��ifl� �, o � �� � _ ���:'� � � .._..� , , , °:" ."'^"�-. >"`�'"�^_.,.�"�""�""""""'-slons�Code�or IhaF�be�axempt�therefrnm ond�he�b��� � Secho,_ -� UTILITYCO:NGTIFfE� - - osis . . .. ... , .... ,... ...,,..� . . .... ... . ; . -.. . . . ., ... . ....�... ... .....:. ..._. .�,:.., . .,.;.... . 1.� . ___. ... '� .,for the�a(leged exorvrpfi�,�..�AnY. . _.,�.y ,. .,. . , .�.,.. . �..,...., vloloiion oi, aection `�%— {� . ' .,...':... :�..T.,.,.,.«,.,..,...�..�u,�^w�rx - . . . � -F�hA� \.. �„ C;,+a.�'nr vvs �ronf �� � � . ,. �703i.5 by ony o�pplicanf�for a��permit sub(ects ths appli- .FN ... . ,.. .. .� , ^ . . , ,,.<..::. ...L.. , ; ... :.,.,.., .,,... �� , , cant�to a,ny�f,.pe�aity-of not mcre_than five-hundred.... ., � t •;.._ i �''i .:.,� -.y ," �.. ....,-.� ...�.. _," �., .,... . .. o rs'$500) . ., e_�.... -.. .�, ,..d I!a � � :hoU5i�2ia�� � „.,.� , .� � � � ..� -� � . [] ,as owner cf iF�e�Propert�v,P,oo the work,cnd� - w4S?EkPP20'vnL a ��t� _, �t 'o-. �., � � � """� �: ""^"`�"""'""'"""'"" '*'thesiructureispot.ntendedorofered�for ale . . t«.. . . �.,y, •e.,�� ��..��._ , �^,-..� . � _�-�-^� - �-=' =a:^�« -{Sec.70A4.Business and Professtons Cod�: Fbe Cc��.�c-. - x.. . ., :.�;. .:.. -�. . _ . . . . . . -. . �'-a"' -" . ' ' ,- ,� , '� ���- --`'.�' '."'.."' �"""'�"'."""".'�:"`,"`-fioF's Cltense Low does rtot appiy to on ommer nf property . ,......:.. ._, . �, , ., . .. , ,� , .. .. .., . . . � . , ., ' �� ; . ,,,,.� .� .,._,, ._..: . _. �. .. wbo�builds or imnroves theraoo, and,who does such • ;,:., , `; � ' , ".,"�.: .;.;�,;, . ,..... k. ,, .... ,...�.�. , ., -w'.-`" �'""`-""'"�'ork hrmself provided thal such Impro'vemenfs�ure nof . � . .;, � �� ,.. , .,�,,, . ; mfendad or offo�ed for sale.lf,however,the building or � �� �-� � �� -^- -^''�• •*-^�^""^�^u��improvement Is iold withirr one yebr�of comp!efion,fhe ,,;. .. .... .,.:.. -._- . ... , ... .. �� �-.--- ��--�� �-����� �- � �� � :,•.. -� � '� owrierrvbuifder wilf have ihe burden of proving ihod�he di! � .. , . . :,:.n,-..,.,�..»....,.�� �»,« �.�.m*�.m...�.�...�,: . .. _�.�._ ,. .:.. . . . ...�... .. .:.:,;. - :�.� . . .... . .,.:.�-• ^ .� ..� """i784 bui(d or improve�ar fhe j�urposQ,of solo.j. ;�� _.,. ...__ . ,, . . . -, . ;. .. , .. . . . � . _ , , � �. . .- . .- , z �", :. , i.: ` . . , .. . 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